Telehealth and the Psychiatric Mental Health Nurse Practitioner: Beyond the COVID-19 Pandemic

Objective: Examine the advantages, disadvantages, and challenges of telehealth for the psychiatric mental health nurse practitioner (PMHNP) in practice and student education. Describe areas for future research and policy development regarding telehealth in PMHNP practice and training during and beyond the COVID-19 pandemic. Methods: Review current evidence, standards of practice, and education for the PMHNP. Results: Recent rapid pandemic-related shifts in utilization of telehealth for clinical practice and student education have highlighted the advantages, disadvantages, and areas in need of additional study. Conclusions: Postpandemic telehealth care delivery will likely persist or expand. PMHNPs must advocate for high practice and education standards

Interpersonal Violence and Contraceptive Method Use by Women Sex Workers

Objective More than one-half of women sex workers (sex workers) in the United States experience interpersonal violence, defined as physical or sexual violence, by sexual partners, including clients or intimate partners. Women experiencing interpersonal violence by intimate partners often choose hidden, woman-controlled contraception (e.g., intrauterine devices, pills, or sterilization) because fear of violence can impede condom negotiation. Yet, little is known about how interpersonal violence relates to contraception among sex workers who may have different sexual partner perpetrators (clients and intimate partners). The purpose of this study was to examine associations between interpersonal violence perpetrated by clients or intimate partners and contraceptive use. Study Design Data are from an observational, prospective cohort of sex workers, aged 18 to 49 in Baltimore, Maryland (N = 218). Bivariate and multivariable logistic regression were used to assess associations between lifetime interpersonal violence and past 3-month contraceptive use. The outcome was any woman-controlled contraceptive use versus partner-controlled or no contraception. Results Nearly all sex workers (96.5%) reported contraceptive use, with most using male condoms (69%), nearly one-half using woman-controlled methods (43%), and 25% using dual methods (e.g., condoms and a woman-controlled method). Lifetime experiences of interpersonal violence by clients (58%) and intimate partners (52%) were prevalent. Sex workers who experienced interpersonal violence by intimate partners had over twice the odds of woman-controlled contraceptive use (adjusted odds ratio, 2.48; 95% confidence interval, 1.36–4.54). Conclusions Findings highlight the importance of relationship context in the associations between interpersonal violence and use of woman-controlled contraceptive methods among sex workers, because only violence experiences by intimate partners were associated with increased odds of woman-controlled contraceptive method use

Impact of the COVID-19 Pandemic on U.S. Women\u27s Mental Health

Background: Women are more likely than men to be diagnosed with depression and anxiety with rates increasing since the COVID-19 pandemic. This study sought to understand how women\u27s intersecting identities, personal strengths, and COVID-19–related stressors were associated with their anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms early in the pandemic. Methods: During May–June 2020, American women (N = 398) recruited via MTurk completed an online questionnaire assessing mental health (PTSD, anxiety, and depression), demographic characteristics, personal strengths (coping, hope, social support), and experiences with COVID-19–specific stressors. Results: Women who had a child younger than 18 years of age, lived in rural or urban areas (compared with suburban), and identified as sexual minority reported increased levels of PTSD, depression, and anxiety symptoms. Social support and hope (Agency) were associated with fewer mental health symptoms. Engagement in maladaptive coping and greater perception of COVID-19 threat and perceived stress was associated with more PTSD, depression, and anxiety symptoms. COVID-19–related illness events and difficulty accessing living essentials were associated with increased anxiety symptoms. COVID-19–related disruption to living and income were associated with increased PTSD symptoms. Loneliness was associated with increased anxiety and depression symptoms. Conclusions: Results of this study can inform prevention and intervention efforts to address depression and anxiety among women with intersecting identities during times of stress. Specifically, supporting the development of women\u27s resilience and adaptive coping and intervening to address maladaptive coping strategies, such as drinking, provide paths to supporting women\u27s mental health

Systematic Review of Contraceptive Use Among Sex Workers in North America

Objective To systematically review the literature regarding contraceptive use by sex workers in North America and to understand factors that limit reproductive agency and affect contraceptive use and decision making. Data Sources We searched PubMed, CINAHL, and Embase databases using the search terms “sex work(ers),” “transactional sex,” “exchange sex,” “prostitution,” “contraception,” “contraceptive agents,” “birth control,” “female,” and “women.” Study Selection Articles were eligible for inclusion in this review if they (a) reported quantitative or qualitative studies based in North America, (b) were written in English, (c) included sex workers (self-identified sex workers or engaged in sex work behavior) as the primary or secondary population of the study, (d) included a population assigned female sex at birth, (e) reported contraceptive outcomes for sex workers, and (f) were published in peer-reviewed journals. The initial search yielded 2,455 articles, and seven met the inclusion criteria. Data Extraction Two authors independently reviewed the articles and organized data in a table to capture study design, sample size and study population, study aims, and contraceptive use. We applied Connell’s theory of gender and power as an analytic framework to further identify factors that limited reproductive agency. Data Synthesis Condoms were the most common method of contraceptive used across studies. The use of contraceptives varied by partner type (client vs. nonpaying intimate partners). Access to highly effective contraception was limited by perceived stigma, financial constraints, and substance use. Reproductive and harm reduction services that were co-located where women worked improved contraceptive use. Contraceptive use was affected by factors that limited reproductive agency, including stigma, substance use, intimate partner violence, and condom coercion. Conclusion The reliance of sex workers on partner-dependent contraception, such as condoms, combined with factors that limit reproductive agency over contraceptive use and decision making contribute to high potential for contraceptive failure and unintended pregnancy. More research is needed to understand the influence of different sexual partner types, pregnancy intention, and contraceptive decision making on the reproductive agency of sex workers

Professionalism in Pre-licensure Nursing Education: Core Values, Didactic Coursework and Clinical Training

Aim To discuss professionalism for pre-licensure nursing students and identify recommendations for inclusion in core values, didactic coursework and clinical training. Background Professionalism is part of the nursing identity that encompasses integrity and honesty. This concept has been difficult to translate into formal education in nursing programs and clinical practice. Design A discursive paper. Data Sources A search of national literature without date restrictions in PubMed, CINAHL, Google Scholar and frameworks for nursing education. We explored principles of professionalism in nursing education and practice. Discussion Evidence-based literature supports the integration of core values of altruism, autonomy, human dignity, integrity, honesty and social justice into didactic curricula, and clinical training. Principles of professionalism can be incorporated intentionally in nursing education to maintain patient safety and trust. Conclusion The principles of professionalism, related to core values of the nursing profession, are abundantly described in the literature. However, these principles represent core values that have not been formally conceptualized. With the changing landscape of healthcare, there is a need for deliberate, measurable integration of professionalism into pre-licensure education. Patient or Public Contribution There was no patient or public involvement in the design or drafting of this discursive paper

Satisfaction and Effectiveness of Opioid Pain Management Among Adults with Cystic Fibrosis: A Mixed Methods Study

Background Chronic pain is common among people living with cystic fibrosis (CF) and associated with worse clinical outcomes. Despite this, little is known about how pain is managed and how opioids are used to treat pain. The purpose of this convergent mixed methods study was to examine self-reported satisfaction and effectiveness of pain management strategies among a sample of adults with CF who are prescribed opioids. Methods We developed an online survey querying 4 domains - demographics, pain characteristics, pain communication, and management strategies. This was distributed nationally to adults with CF (n=48) via various online platforms. We obtained quantitative and qualitative responses regarding satisfaction and effectiveness of pain management. Emerged themes from qualitative data were compared with responses from quantitative survey domains. Results Participants reported high levels of satisfaction and effectiveness with their opioid pain management plans. However, qualitative themes emerged regarding fears of addiction, experiences of feeling stigmatized by the healthcare system and ineffectiveness and inefficiency of alternative therapies for adequate pain relief. Conclusions Adults with CF reported opioids as an important component of their current pain management plans despite risks associated with opioid use. CF-specific pain management guideline development is warranted as is further research exploring pain development

Contraceptive Decision-Making Through the Lens of Social Determinants of Health Among Female Sex Workers: A Qualitative Descriptive Study

Aims The aim of the study was to examine how female sex worker\u27s motivations, desires, intentions and behaviours towards childbearing and childbearing avoidance inform their contraceptive decision-making. We explored the influence of social determinants of health in the domains of social context (sexual partners and experiences of violence), healthcare access, economic instability on the contraceptive decision-making process. Design We conducted a qualitative descriptive study informed by Miller\u27s Theory of Childbearing Motivations, Desires and Intentions through the lens of social determinants of health. Methods Participants were recruited from a parent study, EMERALD, in July–September, 2020. Data were collected from 22 female sex workers ages 18–49 using semi-structured 45 to 60-min audio-recorded interviews and transcribed verbatim. Theory guided the development of the study\u27s interview guide and thematic analytic strategy. Results Five themes emerged related to contraceptive decision-making: Motivations (value of fatherhood), Desires (relationships with love), Intentions and Behaviours (drugs overpower everything, contraceptive strategies and having children means being a protector). Women\u27s contraceptive decision-making often included intentions to use contraception. However, social determinants such relationships with clients and intimate partners, interpersonal violence and challenges accessing traditional health care offering contraceptive services often interfered with these intentions and influenced contraceptive behaviours. Conclusion Women\u27s contraceptive decision-making process included well-informed desires related to childbearing and contraceptive use. However, social determinants across domains of health interfered with autonomous contraceptive decision-making. More effort is needed to examine the influence of social determinants on the reproductive health of this population. Impact Findings from this study build on existing research that examines social determinants impacting reproductive health among female sex workers. Existing theoretical frameworks may not fully capture the influence constrained reproductive autonomy has on contraceptive decision-making. Future studies examining interpersonal and structural barriers to contraception are warranted. Patient or Public Contribution The parent study, EMERALD, collaborated with community service providers in the study intervention

Severity of Post-traumatic Stress and Non-medical, Concomitant Opioid and Benzodiazepine Use in a Sample of Women at High Risk of Overdose

Women who exchange sex and use opioids experience substantial post-traumatic stress disorder (PTSD) symptoms. Among veterans, PTSD increases the risk of concomitant opioid-benzodiazepine use, increasing overdose risk, but this relationship is underexplored in other at-risk populations. We examined correlates of non-medical benzodiazepine use among a cohort of women who exchange sex and use opioids daily (N = 270) in Baltimore, MD. PTSD symptom severity was measured by the full PCL-5 (possible range: 0–80, categorized by tertile as low, medium, high) and four symptom-specific subscales. The prevalence of benzodiazepine use was 27% and the median PCL-5 score was 34. In adjusted models, women with high PCL-5 scores were more likely to use benzodiazepines than those with low scores, overall and across subscales. Severe PTSD symptoms conferred elevated risk of concomitant opioid-benzodiazepine use, calling attention to the importance of addressing trauma in combating the opioid and overdose crises